Evidence of the benefit of simulator training for the education of surgeons

Flexible endoscopy is an important component of many surgeons' practice both historically and today. With the advances in diagnostic and therapeutic endoscopy, acquiring and maintaining knowledge and competency in these skill sets is essential, especially in the training of surgical residents. Attempts to improve resident educational experiences have included focused curriculums, including knowledge and technical skills, dedicated endoscopy rotations, and national recommendations for case volume. Limitations to this education include resident work restrictions, limited numbers of categorical residents, and increasing emphasis on subspecialization. As an attempt to balance these factors, many surgeons have turned to the use of simulation models to supplement clinical exposure in flexible endoscopy. Models must possess construct validity, be able to adequately represent the desired task, and be able to differentiate the novice from the expert. Most importantly, these models must have established external validity, demonstrating an applicability of the skills learned in simulation on clinically applicable technical competency. Documentation of external validity is lacking in the current literature. Specialized clinical evaluation tools, such as the Global Assessment for Gastrointestinal Endoscopic Skills, will help with this. Questions remain, such as who will benefit most from simulation-based learning in flexible endoscopy? How will simulation supplement patient-based learning? Will mentors and trainees accept an independent learning model? Will skills learned on simulators be applicable to clinical care? This article highlights the importance of flexible endoscopy to the surgeon and the importance of teaching and reevaluating the educational system for flexible endoscopy for surgeons.